Cerebral Palsy
Conditions
Keywords
Energetic cost
Brief summary
The purpose of this study is to examine the underlying mechanisms that contribute to high energy costs for people with cerebral palsy (CP) as they walk. The investigators will characterize the cost landscape of children with CP, quantifying the magnitude of cost (net nondimensional oxygen consumption) associated with walking and common sub-tasks of walking, such as supporting and stabilizing the body.
Detailed description
Children with CP use large amounts of energy to walk and move, leading to fatigue and limiting participation. For people with CP the energetic cost of walking is on average over two times higher than typically-developing (TD) peers. This means that for people with CP, walking is as tiring as jogging or climbing stairs. An energetic cost of this magnitude restricts activities of daily living (ADL) and causes exhaustion. While the investigators and many others have sought to reduce these energetic costs through surgical interventions, rehabilitation, orthotics, or other assistive devices, these strategies have failed to result in meaningful reductions in energy. To design strategies that successfully reduce walking costs, the investigators must first understand the underlying mechanisms contributing to elevated cost in people with CP. This basic-science research will provide the foundation to create evidence-based strategies to decrease energy costs, minimize fatigue, and increase quality of life for people with CP and other neurologic injuries.
Interventions
OTHERVarying levels of harness support during walking
Participants will complete a standard gait and motion analysis at varying levels of harness support and stabilization (low, moderate, and high levels).
Sponsors
University of Washington
Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
Gillette Children's Specialty Healthcare
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
BASIC_SCIENCE
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
8 Years to 17 Years
Healthy volunteers
Yes
Inclusion criteria
for Cases: * 8-17 years old * Diagnosed with bilateral cerebral palsy * Gross Motor Function Classification System II * No surgery within the last 9 months * No current baclofen pump or explantation in the last 2 months * No botulinum toxin or phenol injections in the last 2 months * Had a prior gait and motion analysis at Gillette Children's Specialty Healthcare * Participant and caregiver able to speak and read English * Ability to follow instructions Inclusion Criteria for Controls: * 8-17 years old * Participant and caregiver able to speak and read English * Ability to follow instructions
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Net Nondimensional Oxygen Cost | Baseline walking trial with harness on (5-minutes) and support walking trials with vertical or lateral support in harness system (5-minutes) | Steady-state net nondimensional oxygen consumption while walking on a treadmill. Percent change in oxygen consumption was evaluated between baseline without support and with vertical and lateral support. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Three-dimensional Gait Kinematics (Baseline) | Initial trial without support (5-minutes) | Five features describing kinematics during gait in the harness system without vertical or lateral support collected from marker-based motion capture. Since the harness system differed between vertical and lateral support, baseline kinematics are reported separately for each system in the rows below. The features include (1) median pelvic tilt during the stance phase, (2) peak hip extension, (3) peak knee extension, (4) peak ankle plantarflexion, and (5) the foot progression angle relative to fore-aft direction. |
| Three-dimensional Gait Kinematics (Support) | Trial with maximum support (5-minutes) | Five features describing kinematics during gait in the harness system with vertical and lateral support. The features include (1) median pelvic tilt during the stance phase, (2) peak hip extension, (3) peak knee extension, (4) peak ankle plantarflexion, and (5) the foot progression angle relative to fore-aft direction. |
| Three-dimensional Gait Kinetics (Baseline) | Initial trial without support (5-minutes) | Three features describing kinetics during gait in the harness system without vertical or lateral support collected from marker-based motion capture and instrumented treadmill for ground reaction forces. Since the harness system differed between vertical and lateral support, baseline kinematics are reported separately for each system in the rows below. The features include (1) peak hip extensor moment, (2) peak knee extensor moment, and (3) peak ankle plantarflexor moment. |
| Three-dimensional Gait Kinetics (Support) | Trial with maximum support (5-minutes) | Three features describing kinetics during gait in the harness system with vertical and lateral support. . Since the harness system differed between vertical and lateral support, baseline kinematics are reported separately for each system in the rows below. The features include (1) peak hip extensor moment, (2) peak knee extensor moment, and (3) peak ankle plantarflexor moment. |
| Passive Joint Range of Motion | One-time research visit (15 minutes) | Compare passive joint range of motion (degrees) measured by lower extremity physical exam |
| Selective Motor Control | One-time research visit (15 minutes) | Selective motor control (0 patterned movement - 2 complete isolated movement) |
| Lower Extremity Strength | One-time research visit (15 minutes) | Lower extremity strength measures by the manual muscle test (0 no muscle contraction - 5 typical muscle function) |
Countries
United States
Contacts
PRINCIPAL_INVESTIGATORKatherine Steele, PhD
University of Washington
PRINCIPAL_INVESTIGATORMichael Schwartz, PhD
Gillette Children's Specialty Healthcare
Participant flow
Recruitment details
Participants were recruited through Gillette Children's via electronic medical record search, flyers, social media postings, and word of mouth at local clinics and community organizations. Recruitment started in the Summer of 2023, after a delay due to a facility flood, and was completed in the Summer of 2025.
Baseline characteristics
| Characteristic | — |
|---|---|
| Age, Continuous | 12.8 years STANDARD_DEVIATION 2.9 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 1 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 9 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants |
| Race (NIH/OMB) Asian | 1 Participants |
| Race (NIH/OMB) Black or African American | 1 Participants |
| Race (NIH/OMB) More than one race | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants |
| Race (NIH/OMB) White | 10 Participants |
| Sex: Female, Male Female | 9 Participants |
| Sex: Female, Male Male | 15 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 24 | 0 / 10 |
| other Total, other adverse events | 0 / 24 | 0 / 10 |
| serious Total, serious adverse events | 0 / 24 | 0 / 10 |
Outcome results
None listed